Philosophy At George Mason University Linda Royer Master 's In The .

real reasons for the U.S. and global nursing shortage are complex and due to many interrelatedfactors such as the public image of nurses, career selection (for men and women), education,age at entry into the workforce, workforce participation, job structure and work demand, careerlongevity, and economic conditions. Therefore, equations of supply vs. demand or graduates vs.vacant positions do not fully explain the shortage or its implications (Buerhaus, Auerbach, &Staiger, 2007).The RN shortage affects specialties and subspecialties; in PH it has been deemed farmore serious than any experienced in the U.S. before now (QuadCouncil, 2006), partly becausethis is a time of limited success in recruiting new graduates (Leep, 2007) due to employmentretention problems—particularly of well-educated, experienced nurses. Once these facts werereleased, educational institutions innovated ways to attract students by creating curriculumdesigns that would optimize time and space and availability of faculty to meet an increasingenrollment. As these students have graduated in the past 4 years they have entered theworkforce, thus reducing the shortage to a small degree—temporarily (Buerhaus et al., 2009).Because of the larger aging cohort of mature nurses, their retirement soon will extend therecruitment demands, prolonging the nursing workforce shortage. Complicating ourunderstanding of the C/PHN shortage is the difficulty in getting an accurate “count” of them atany point in time. There is a paucity of data on C/PHN supply and demand, in part because datacollection is hampered by a lack of a knowledge of their full range of functions and jobexpectations, a lack of a standardized definition of PHN roles, and variation in hiring andemployment practices (GAO, 2001; HRSA, 2000, 2002, 2004, 2005; QuadCouncil, 2006).3

Institutional Concerns of the SystemManagers, policymakers, and nurses alike were concerned about the health system’sorganization and management. Institutional conditions have fallen short in several areas: inmeeting the health system providers’ requirements, in the public’s perceptions about their needof care, in generating adequate funding to finance the care, and in recognizing the care givingnurses’ attitudes about commitment to the profession and the job (Buerhaus et al., 2007; GAO,2001; Reineck & Furino, 2005). Competent nurses adapt to change, are good communicators,excel in assessment and critical thinking, are problem-solvers, and are capable of leadership.Their importance is evident in health care delivery to assure patient safety in the acute hospitalsetting (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002). Therefore, U.S. health care leaders andnurse researchers alike are interested in how the nursing shortage affects other related matterssuch as the increasing demand for care, retention and satisfaction of registered nurse (RN)employees, recruitment and retention programs, and nurses’ efficiency (Buerhaus et al., 2007;HRSA, 2002, 2004, 2005, 2006). Employers and policymakers are becoming concerned aboutwork design, staffing, working relationships, and other factors that may influence patientoutcomes (Aiken et al., 2002).Documentation by ResearchIn order for the nurse to make an optimum contribution to community practice, thework environment and relationships within the community should have a structure that fosterssatisfaction and the sense of empowerment (Manojlovich, 2007) (Also refer to Appendix A,Tables A1 and A2, for definitions in this study). Empowerment should be evident in the nurse’sdegree of work productivity, level of commitment to the job or entity, and intention to remain4

at that job. Nurses who are fulfilled, experience role clarity, and express job satisfaction shouldattract other nurses. Recruiting and retaining this valuable health care system asset (the nurse)is crucial for present and future needs, and all the more so in the community—on the frontier ofprevention efforts—where an increasing need for qualified and competent nurses is felt in outpatient settings, schools, and public health.Compared to the quantity of research done on nurses working in acute care settings,there is little research about C/PHNs and factors that affect their work contributions, workplaceconditions, and workforce participation in local health departments (LHD) and State healthdepartment (SHD) levels (PH system entities). This is especially true for concerns about C/PHNjob satisfaction and tenure. Consequently, there is interest among PH nursing leaders about thecontributions, satisfaction, and retention as well as the impact job structure, performanceexpectations, and institutional policies (job design, pay, and benefits) may have on short- andlong-term recruitment and retention of C/PHNs (ASTDN, 2007; QuadCouncil, 2006). What betterway to document these concerns than to lay a foundation of inquiry of the C/PHNs themselves?Statement of the ProblemThere is a limited amount of data about C/PHNs and their perceptions of job satisfactionand practice empowerment in PH organizations, given the varied nature and complexity of theirnursing roles and the relationship between institutional factors such as job, salary,organizational culture, and climate that are thought to affect C/PHN practice, satisfaction, andretention. Furthermore, it is important to know C/PHN perceptions about their job’s meaningand impact, and beliefs about their employers related to institutional commitment, promotionof nurse competence and self-determination, and information sharing (Spreitzer, 1995a, 1995b).5

Also needed is information thought to affect job/organizational commitment and C/PHNs’attitude about intent to stay on the job (Meyer, Allen, & Smith, 1993; Meyer et al., 2004). Suchinformation may provide empirical data to aid PH managers in creating a work environmentconducive to recruiting and retaining C/PHNs and may also contribute to better decisions bypolicymakers and others shaping nursing workforce development and public health systems inthe future.Need for This StudySome researchers have found that C/PHNs experience a variety of barriers andlimitations in their practice that point to uncertainties and complexity in workplaceorganizational structure and internal problems in relationships and communication, andrecommend further examination of these issues (Flynn, 2007; Laschinger, Finegan, Shamian, &Wilk, 2001; Laschinger & Finegan, 2005; SmithBattle, Diekemper, & Leander, 2004; SmithBattle,Diekemper, & Drake, 1999, 2004). This study is needed, then, to understand factors that mayaffect C/PHN work, job satisfaction, empowerment, and job retention. It is hoped that such datawould contribute to the future decisions of PH administrators, nursing leaders, and educators ofC/PHNs alike about various aspects of PH development and workforce management. Inparticular, it is important to know how C/PHNs view their job in terms of meaningfulness,relevancy, and clarity, and whether it provides resources and other supports for advancedindependence and collaboration.6

PurposeThe purpose of this study was to examine the relationships between C/PHN perceptionsof structural and psychological empowerment in the workplace and organizational factors, nursedemographics as they relate to professional practice, commitment, and intent to leave the job.The frameworks that inform this study are Spreitzer’s Theory of IntrapersonalEmpowerment and the Meyer and Allen Employee (or Occupational) Commitment and Measureof Career Change (see diagram in Appendix B). The results of this study are expected to informhealth leaders, employers, and policymakers about factors influencing C/PHN recruitment andretention success in the health system.Significance of the StudyGiven the need for public health system improvement (Baker et al., 2005; Green, 2006;IOM, 2002) and consistent with recommendations called for by the National Association of Cityand County Health Officers (NACCHO, 2006), this study builds upon the body of knowledgeabout the linkages between institutional factors and structural and psychological empowermentof C/PHNs in PH organizations. It is anticipated that these study results will provide usefulinformation to public health system administrators about organizational factors (functions,resources, and policy) and nurse recruitment and retention. It is also anticipated that PHNsupervisors and managers may benefit from the information so that strategies to improve localorganizational structures and working relationships with C/PHNs may be undertaken.Research QuestionsIn order to achieve the study’s purpose, the following questions were explored (refer toAppendix C for study instrument):7

1.What are the descriptive characteristics among respondents in the categories ofwork location and structure, RN leadership, personal attributes (gender, age,race/ethnicity), education, work (status, method, tenure, role, dual jobs, sense ofEmpowerment, and type of Commitment in relationship to the degree of theirIntent to Leave the job?2. What are the relationships between respondents’ characteristics of work locationand structure, RN leadership, personal attributes (gender, age, race/ethnicity),education, work (status, method, tenure, role, dual jobs, sense of Empowerment,and type of Commitment in the context of the degree of their Intent to Leave thejob?3. What factors such as demographic characteristics, Empowerment and Commitmentincrease the likelihood of C/PHNs’ Intent to Leave the job?DefinitionsFor the purpose of this study the following conceptual and operational definitions ofdemographic characteristics were utilized in the survey potentially for Predictor and CriterionVariables (also refer to Appendix B, Tables B1-B4).Demographic characteristics (Refer to Table 1):1. Location: State2. Location: (a) urban/metropolitan area, (b) rural3. Type of health department: (a) city, (b) county, (c) district, (d) state4. Presence of nurse supervision: (a) yes, (b) no8

5. Work Position: (a) Public Health Nurse, (b) supervisor, (c) program director, (d)administrator/director, assistant director, (e) consultant, (f) bioterrorismcoordinator, (g) school nurse, (h) community clinic nurse, (i) case manager6. Age group: (a) 22-34 years, (b) 35-45 years, (c) 46-55 years, (d) 56-65 years, (e) 65 years7. Gender: Male/Female8. Race/Ethnicity: (a) Caucasian, (b) African-American, (c) Native American, (d) Asian,Pacific Islander, (e) non-white Hispanic, (f) Hispanic9. Educational achievementa. Diploma – Nursingb. Associate degree – field other than Nursingc. Associate degree – Nursingd. Baccalaureate degree – Nursinge. Baccalaureate degree – field other than Nursingf.Master degree – Nursingg. Master degree – field other than Nursing or Public Healthh. Master in Public Healthi.Doctorate – Nursingj.Doctorate – Public Health or Healthcare Administrationk. Doctorate – other field10. Practice credentials:a. Certification in Public Health Nursing, (year)9

b. Other certification/post-Master’s credentials11. Current work status:a. full-time (30 hours or more/week)b. part-time (less than 30 hours/week)c.casual (occasional or as needed, may or may not be contract)12. Experience in Public Health (tenure):a. 1 year (1-11 months)b. 1-3 years (12-36 months)c. 4-10 years (37-120 months)d. 10 years (more than 120 months)13. Job Method:a. traditional and population-oriented (prevention activities, communityeducation, home visiting, schools, etc.)b. grant-driven, population-basedc. program for specific disease or condition management (TB, STDs, AIDS/HIV,prenatal, etc.)d. grant-supported but program-specific14. Work other job:a. Yesb. No10

SurveyPART I (Spreitzer instrument): For Conceptual and Operational Definitions, refer toAppendix B Table B3.PART II (Meyer & Allen instrument): For Conceptual Definitions, refer to Appendix BTable B4.Perceptual relationships of two concepts: Empowerment—(characterized by 8subscales—independent variables), Commitment (characterized by 3 types—independentvariables), and Intent to Leave or Career Change—dependent variable) among C/PHNs wereexamined. For regression procedures 2 predictor variables, 1 criterion variable, were available tomanipulation and analysis. In Sprietzer’s theory employees gain control over their work whencertain organizational factors and relationship supports exist in the workplace, influencingemployee beliefs, behaviors, and work output (Spreitzer, 1995a, 1995b, 1996; Spreitzer,DeJanasz, & Quinn, 1999). For this study, the items Work Output (innovation and workeffectiveness) and Span of Control were not used because the focus is on a general C/PHNpopulation rather than a combination of staff and management. That is recommended as asecond stage of study comparing self-assessments by staff nurses to managerial appraisals(Spreitzer, 1995b).Meyer and Allen’s Employee Commitment construct differentiates

Master 's in the Science of Nursing University of Virginia, 1996 Master 's in Public Health Loma Linda University, 1985 Director : Dr. P. J. Maddox School of Nursing Fall Semester 2009 George Mason University Fairfax, VA